Individual
KAITLYN GORDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BCABA
Contact information
Practice address
1301 MUSEUM RD, CONWAY, AR 72032-4739
(501) 358-6535
Mailing address
1301 MUSEUM RD, CONWAY, AR 72032-4739
(501) 358-6535
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
0-22-13843
AR
106S00000X
Behavior Technician
—
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1255980199
—
AR
Enumeration date
09/04/2019
Last updated
07/28/2022
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